An unusual epithelioid variant of perineurioma of the groin occurring in a 53-year-old man is described. The lesion appeared to be associated with a femoral nerve branch. The tumour was characterised by the presence of a syncytial proliferation of epithelioid cells, mimicking a meningioma of syncytial type. In addition there was a minor component of a conventional perineurioma. The tumour cells were EMA+, claudin-1+ and collagen type IV+. Bcl 2 was focally expressed. This case highlights the possibility of a common histogenetic pathway for meningiomas and perineuriomas. Although ultrastructural evidence of possible meningiomatous differentiation within an otherwise histologically typical perineurioma has been described, this is the first reported case of an unconventional epithelioid variant of perineurioma, histologically resembling meningioma.
Summary A series of 45 patients (31 female) underwent clam enterocystoplasty for urgency and incontinence. The majority had detrusor instability. Prolonged conservative treatment had failed in all cases. Improvement occurred in 71% and those younger than 30 years had better overall results; 29% remained incontinent, with 9% requiring a urinary diversion. Many patients did not achieve maximum benefit until 9 months post‐operatively. Surgery had no statistically significant effect on any urodynamic parameter and post‐operative complications were common. The operation was performed in either the coronal (19) or the sagittal plane (26); this did not influence results. In general, surgery was found to be technically simpler in the sagittal group and it is recommended that this becomes the standard procedure. We feel that this operation involves major surgery and should only be offered with reluctance.
The need and ability to drain retained urine from the bladder has been recognised from prehistoric times. Man’s ingenuity was nowhere better exemplified than in the variety of materials and objects used to catheterise the urethra. Reeds and straws were commonly used. The Chinese accomplished the task with the dried, rolled up, outer leaves of a species of onion. In the eastern Mediterranean the Sumerians, Babylonians and Egyptians used gold and silver to manufacture catheters. Metal catheters were also recovered in the excavations at Pompeii. Galen devised an “S”-shaped catheter which indicated his clear understanding of the natural curves of the male urethra.
Summary— We present the results of a prospective randomised trial of Estradurin, a long‐acting oestrogen preparation (polyoestradiol phosphate), 160 mg per month, compared with bilateral orchiectomy in patients with advanced prostatic carcinoma (T3M1; T4MO/M1). The dose was lower than that usually recommended to induce a consistent fall in serial plasma testosterone levels to within the castrate range. Most patients treated with oestrogen showed an initial clinical and biochemical response equal to that obtained for patients undergoing orchiectomy. The inevitable relapse in hormone sensitivity sometimes occurred very soon after the start of oestrogen treatment. Many patients had poorly suppressed plasma testosterone expressed as a mean of monthly serial measurements, but then responded to secondary orchiectomy. These data only suggest that, in the treatment of hormone‐sensitive prostatic carcinoma, it may be necessary to reduce plasma testosterone to midway between castrate and normal ranges. The data support the theory that response to androgen withdrawal is qualitative rather than quantative. The effective dose of oestrogen may therefore be reduced and the risk of thrombo‐embolic complications minimised.
Objective To determine what effect the presence of a nephrostomy, left on free drainage, might have on the rate of occurrence of ureteric strictures after ureteric instrumentation. Patients and methods Eighteen patients were identified in this unit who had had ureteric instrumentation while a nephrostomy was in place. Results Eight of 11 patients in whom the nephrostomy was left open developed ureteric strictures. None of seven patients in whom the lumen was maintained by stenting and and/or clamping of the nephrostomy developed strictures. The strictures needed dilatation and stenting in seven patients and ureter had to be reimplanted in the other. Conclusion In patients in whom a nephrostomy is in place, the opening should be occluded after ureteric instrumentation or a stent should be inserted if it is to be left on free drainage.
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